PROBATE COURT OF LUCAS COUNTY, OHIO

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PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE IN THE MATTER OF THE DISINTERMENT OF: _______________________________________, DECEASED CASE NO. _________________________ AFFIDAVIT OF NOTICE OF NON-NOTIFICATION The undersigned Applicant states that the names or addresses of the following persons are unknown to the Applicant and cannot be ascertained with reasonable diligence. The Applicant further states that the following persons, for reasons stated above, were not notified for good cause: I certify that, to the best of my knowledge, the above statement is true. Applicant Sworn to and subscribed in my presence this day of________________________, 20___. Notary Public FORM LCPC – DIS300F «ejt411GX−

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